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A Review of Digital Tools for Clinical Learning

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A Review of Digital Tools for Clinical
Learning
Hope Onyeka Igbonagwam1, Mumini Abiola Dauda2, Shuaibu O. Ibrahim3,
Ifiok Patrick Umana4, Samuel Kelechi Richard5, Ugo Uwadiako Enebeli6,
Oladimeji Adebayo7, Mumeen Olaitan Salihu8, Dare Godiya Ishaya9,
Website: Suleiman Abiodun Isma’il10, Muhammad Sani Kabir10, Oyinkansola Agaja11,
www.jmwan.org Temitope Toluse Selowo12
DOI:
10.4103/jmwa.jmwa_13_22
Abstract:
1
Department of Family This study presents a comprehensive review of digital tools used in clinical learning at a time when
Medicine, Federal Medical clinical learning is moving from its core traditional format to digitalised tools. This transition has
Center, Owerri, Imo State, been hastened and made more imperative by the coronavirus disease 2019 pandemic. The review
2
Department of Restorative highlights the main digital tools used for clinical learning, the challenges, benefits and prospects of
Dentistry, Lagos University digital tools in clinical learning. These digital tools have made some gains and in this rapidly expanding
Teaching Hospital, Lagos digital age, and the onus rests on students, medical educators and training bodies to keep abreast
State, 3Department of with its scope and possibilities, as well as its challenges and limitations, for the best outcomes in
Anaesthesia, Federal the application of digital tools to clinical education.
Medical Centre, Katsina, Keywords:
Departments of 4Surgery, Clinical learning, digital tools, e‑learning, technology
5
Histopathology and
12
Chemical Pathology,
Jos University Teaching
Hospital, Jos, 6Department Introduction being taught. Learning in a clinical context
of Community Medicine, is prerequisite in the training of health
University of Port Harcourt
Teaching Hospital, Port
Harcourt, Departments
I n recent years, learning in all sectors
has moved from core traditional style
to incorporate predominantly digital
professions; there is no alternative and
there is also no comparison to the learning
that comes from managing patients in real
of 7Medicine and approaches due to technological evolution, clinical scenarios.[1] Clinical learning and
11
Paediatrics, University thus patient management have become
as well as the coronavirus disease
College Hospital,
2019 (COVID‑19) pandemic. [1] Clinical easier with the advent and use of digital
Ibadan, 8Department of
learning dates as far back as the ancient tools in everyday clinical practice.
Behavioural Sciences,
University of Ilorin Greeks’ method of rational inquiry, which
Teaching Hospital, Ilorin,
Clinical learning involves the application
introduced the practice of observation and
Kwara State, Departments of knowledge and skills to patient care. It
reasoning regarding diseases. Rational
of 9Internal Medicine involves participation in supervised learning
interpretations and discussions led to the
and 10Family Medicine, sessions in healthcare environments, which
Abubakar Tafawa Balewa teaching and formation of schools such help the learners to apply what they have
University Teaching as that at Cos, where the Greek physician learnt in the classroom into practice.
Hospital, Bauchi, Nigeria Hippocrates is said to have taught in the It can take place in different settings
5th century BC and originated the oath.[1] across the health sector and supervised by
Address for
correspondence: experienced practitioners and teachers who
Dr. Ugo Uwadiako Enebeli,
‘Clinical’ refers to the examination and foster students’ critical thinking and clinical
Department of Community treatment of patients while learning is skills safely. The future of medicine is
Medicine, University of referred to as the acquisition of knowledge changing based on advances in information
Port Harcourt Teaching
or skills through study, experience or and communication technology, and the
Hospital, Port Harcourt,
Nigeria.
This is an open access journal, and articles are
current classroom model seems to have
E‑mail: doctorenebeli@ distributed under the terms of the Creative Commons
yahoo.com Attribution‑NonCommercial‑ShareAlike 4.0 License, which
allows others to remix, tweak, and build upon the work How to cite this article: Igbonagwam HO, Dauda MA,
Submitted: 23‑Aug‑2022 Ibrahim SO, Umana IP, Richard SK, Enebeli UU, et al.
Revised: 28‑Oct‑2022 non‑commercially, as long as appropriate credit is given and
the new creations are licensed under the identical terms. A review of digital tools for clinical learning. J Med
Accepted: 01‑Mar‑2023 Womens Assoc Niger 2022;7:29-35.
Published: 04-Sep-2023 For reprints contact: [email protected]

© 2023 Journal of the Medical Women’s Association of Nigeria | Published by Wolters Kluwer - Medknow 29
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Igbonagwam, et al.: Digital tools for clinical learning

difficulties in fully preparing students for the future of entirely depends on the technology chosen for the job
medicine.[2] and how educators adapt to them.

Today, technology is ubiquitous, and many individuals There are virtual teaching tools out there for every different
and firms adapt to it in their daily lives. Since the teaching approach for different age groups’ needs and
beginning of the 21 st century, the world has seen abilities. These tools cover over a wide range of things
significant technological advancements. The emergence from colleague interaction, video classrooms, classrooms,
of smartphones, the Internet, computers, social media to managing schedule and sticking to work hour.[6]
and websites has paved the way for the development of
digital tools that will enhance educational teaching and Some digital tools are as follows:
learning processes. There are more digital tools that are
being adopted in education at present, and they have Zoom
become the most important tools to help teachers and The COVID‑19 pandemic popularised the Zoom
students improve their communication, collaboration platform. In addition to using Zoom to video call family
and creativity skills.[3] members, it is a useful tool virtual classrooms and
departmental meetings. This popular video conferencing
This study aims to review the various digital tools for platform allows more than 100 participants and helps
clinical learning, the benefits of these tools, particularly create several breakout rooms, share screens and use
in the COVID‑19 pandemic, the challenges associated group chats for smaller discussions during a lesson. It
with their use and their prospects in order to proffer provides the opportunity to easily record lectures and for
recommendations on the use of digital tools for both sharing meetings with colleagues who could not attend.[6]
students and medical educators.
Google classroom
Digital Tools for Clinical Learning Learning management system software provides a
single space for all organisations’ administration,
Digital learning includes teaching and learning that is documentation, reporting and training needs, in addition
enabled by information and communications technology, to the tools to plan teaching, host virtual lessons and
both inside and outside the classroom.[4] The use of create assignments. Google Classroom brings together
digital tools is the new trend in teaching and assessment all its standard G Suite tools such as Docs, Sheets and
methods. [2] The digital technologies introduced in Hangouts, to help seamlessly manage and deliver virtual
medical and dental education include Google Forms teaching.[6]
to collect students’ answers, Zoom video conferencing,
YouTube live streaming, Google art and culture (an Computer‑aided instruction (computer‑assisted
online art museum) and choose‑your‑own‑adventure learning)
as a story‑telling technique.[2] This learning method has the advantage of being able
to easily visualise complex procedures, and its principal
Digital tools are programmes, websites or online advantage may be excellent accessibility.[7] Through the
resources that can make tasks easier to complete. widespread use of the Internet and various electronic
Many digital tools can be accessed everywhere via devices, clinical education, which conventionally could
web browsers that do not require downloading, and only be conducted in the school setting, and especially in
that are accessible anywhere. Digital tools, such as practice rooms, can now be carried out at home, on the
websites, applications (apps) and their extensions, offer road and above all repeatedly at the pace of learning until
interesting digital learning experiences.[3] Digital tools the students are fully acquainted with the corresponding
provide a way to implement text, images, audio and material. Wang conducted computer‑aided training
video for an immersive experience. Frequently used in pharmacology practice classes for Australian
digital classroom learning tools such as Chromebooks, medical school students and then surveyed students to
Airtame (for wireless presentations) and tablets offer evaluate their understanding through a standardised
participatory and explorative digital learning for questionnaire. [8] In their study, 98.7% of students
students.[5] successfully achieved their learning goals with a positive
result.[8] This method has some limitations, as the content
COVID‑19 fundamentally changed education, forcing provided on some screens may be insufficient to replace
hundreds of colleges, universities, schools, training in‑person teaching and physical practice.[8]
centres and tutors to move physical teaching to virtual
settings. While many institutions and public learning YouTube
spaces are now reopening, hybrid forms of teaching are YouTube is an online video platform wherein its
likely to continue for a while. The success of this model users can upload videos worldwide. [2] In addition,
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Igbonagwam, et al.: Digital tools for clinical learning

there is a large volume of educational content on Interactive learning

YouTube, thus it can be used as a digital tool for Interactive whiteboards allow students to interact with
learning.[2] Teachers can create a personal channel on the learning material. The students become a part of
YouTube and post educational materials for flipped the lessons, and they can also teach each other.[10] With
learning so that students can watch the material interactive whiteboards, students are able to provide
before class. The biggest advantage of YouTube is immediate feedback, such that both learners and educators
that students can easily access YouTube on any device can ascertain the progress of the learning sessions.
without even signing in, and they are already fully
comfortable with how to use the platform. Another Ease of use and access to sources of support
important feature of YouTube is the recommended Interactive whiteboards are easy to use using a specialised
playlists displayed on the top right. The YouTube pen; they are also easy to maintain.[10] In addition, they
algorithm automatically selects similar content and are Internet enabled and offer access to various sources
provides suggested videos alongside. Students can of support, educational information and online tools.
make connections with the original video and acquire
profound insights related to materials by watching Electronic books
similar videos from different viewpoints. In addition, Electronic books (e‑books) have become prevalent
by using the basic streaming function of YouTube, it amongst the general population, as well as students,
is possible to provide real‑time interactive classes to owing to their advantages over traditional books. Some
remote students. However, YouTube live streaming schools have been able to integrate e‑books into their
clearly has the disadvantage of being unable to classrooms, as shown in a South African study.[11] In order
evaluate students’ reactions face‑to‑face, although to realise the potential of e‑books and their associated
students can at least communicate through comments devices within an academic context, where reading
in real time. Fortunately, this technical limitation can speed and comprehension are critical for academic
be easily overcome by using various types of video performance and personal growth, the effectiveness of
conferencing tools, especially Zoom or Google Meet.[5] reading from a tablet screen should be evaluated.[8] The
results of this study indicate the majority of participants
Cell phones read faster on an iPad, which is in contrast to previous
Smartphones are becoming more common in school studies that have found reading from tablets to be
because they offer a variety of benefits beyond calling/ slower.[8] It was also found that comprehension scores did
texting communications, quick answers and social not differ significantly between the two media (tablets
media. Cell phones can be applied to educational uses, and iPad). In general, this shows that e‑books can be
as demonstrated by a world scientific news study of introduced without concern that reading performance
274 students (159 males, 115 females), in which 36.5% and comprehension will be hindered.[11]
agreed that mobile phones assisted them in their
learning.[9] The students also posited that cell phones Podcasts
were an important means of international interactions Podcasts have become the shorthand for audio‑only
between fellow students and educators. Despite some media. It was originally synonymous with audio‑only
downsides to smartphones in the classroom, such as files shared on the Internet with the mediation of a
distractions, uptraining and failed multitasking attempts; radio station. Podcasts are cheap to produce compared
the benefits of easy and mobile access to educational to video content and allow for natural flows in the
sources seem to outweigh the negatives.[9] conversation between hosts and guests. Performers or
experts use podcasts to cultivate an audience and make
Interactive whiteboard that audience feel part of a wider community.[12] This
Interactive whiteboards allow educators to take standard has benefits for educators looking to create a feeling of
lessons and turn them into interactive activities. belonging in distance education. Professional podcasting
Interactive whiteboards like the Sharp Aquos Board are has proliferated since 2010. There is a growing trend of
replacing overhead projectors in classrooms across the using freely available podcasts in teaching and learning,
nation. Some advantages of interactive whiteboards are both as a trigger for discussion or to reinforce learning.
as follows: [10] With audio, students can listen anywhere, anytime, using
mobile devices. As they are only an audio stream, they
Enhanced lessons use very little mobile data.[12]
Educational contents are enhanced by interactive
whiteboards which equip teachers with new, innovative Films
ways to teach the same subject material. Because it Films are particularly important in education because
offers students the ability to view, hear and touch, they help students to retain information for a longer
they (students) learn better and remember more.[10] time. Pictures and words are processed differently in
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Igbonagwam, et al.: Digital tools for clinical learning

our brains, making the information stick longer than These have led to a massive shift from conventional
when reading print media. It helps students grasp face‑to‑face learning, teaching and assessment to that
information regarding different topics. Viewing the of an online interface. Some examples of these digital
film in the classroom gives visual representation to tools that have facilitated clinical learning include online
abstract thoughts, and seems to aid better retention reference materials, games, blogs and search engines.
than reading texts alone. [13] It helps students gain
in‑depth knowledge, develops critical interpretation The use of online reference materials and search engines,
and actively involved students in their studies.[14] When such as eMedicine, UpToDate, Medscape, Google
teaching abstract material in multicultural academic Scholar, ResearchGate and Wikipedia, has shifted
colleges, it is especially important to create a classroom clinical learning to an unprecedented new height.[17]
climate that encourages all students to bring their own The interface and resources available from these tools
authentic selves to the classroom. In such a climate, the have immeasurable advantages and usefulness to the
instructor works hard to bring her or his whole self to end-users as well as the facilitators. However, some
the classroom. Watching films enable students to make studies conducted have shown the information contained
the connection between theory and real‑life situations.[14] in these tools and resources are not always authentic
and accurate, as there are errors contained in them.[17]
Digital cameras Applications and game‑based learning tools are also part
Digital cameras are used to enhance learning, provide of the curriculum of some schools in developed nations
motivation and as a convenient tool to empower both and are utilised as tools for clinical learning.
students and teachers. Cameras are becoming easier to
use, smaller, cheaper and powerful. Teachers and students Social media
can now readily produce and use digital images with ease Social networks and virtual communities hold great
in any learning area.[15] This is perhaps a justification for value as a teaching learning tool.[18] They may appear
the inclusion of digital cameras in the curriculum.[15] relatively novel or unfamiliar tools to some educators
but not with the Internet‑savvy students. Social media
Scanner provide a user‑generated and collaborative dimension
Scanning software is an electronic device that replicates of participatory learning. [9] Social media enhance
the digital representation of an image, such as a photo medical and clinical learning by facilitating engagements
or document for data input into a computer. A scanner and self‑reflections. They provide real‑life learning
optically generates digital images from printed texts and experiences as students may be expected to tweet
images, which are in paper format. In a school setup, questions as lectures are ongoing.
many people can use the scanner as the scanning software
is essential to office attendants, teachers and students.[16] Teleconferencing
As a learning aid, a scanner benefits both the teacher Teleconferencing is used in continuing medical
and students in that it helps the teacher and students education courses, post‑graduate medical education and
to replicate learning materials such as documents and telementoring.[19‑21]
images, capture and store images. It is easy to use,
fast and convenient, especially for students above the Online medical applications
elementary level. In a classroom, the scanning software Numerous applications (Apps) assist health‑care
is very powerful and invaluable if used together with a practitioners with many important tasks, such as clinical
computer and a whiteboard. In class, a scanner would decision‑making, medical education and training. Some
be very handy in reproducing all sorts of documents and of the popular medical applications include mHealth,
images. To use a scanner as a learning aid, a teacher needs Brainscape, AnkiMobile, Quizlet, MDCalc, prognosis,
a document, text or photograph, a scanner and several daily rounds, human anatomy atlas, Epocrates,
networked computers that are functioning well.[16] Medscape, Micromedex and PEPID. They are designed
to make clinical learning easier in this technological
Websites and applications: Online reference advanced world.[22]
materials, games, blogs and search engines
Content websites and applications have been in use Some other online technological communication
for clinical learning for some time; however, their platforms identified that are changing clinical training
widespread use has been facilitated by recent advances include Hangout, Future learn, Teams, Google Classroom,
in technology and the recent COVID‑19 pandemic.1[7] Code Academy, Wevideo, Examus, Coursera, ClassDojo,
Adobe Captivate, Classtime, Claswize, Neo, Articulate
1 Wong A, Ho S, Olusanya O, Antonini MV, Lyness D. The use
360, Edmodo, Blackboard Learn, Docebo, Buncee,
of social media and online communications in times of pandemic
COVID-19. Journal of the Intensive Care Society. 2021;22(3):255-260. Bakpax, Elucidat, FeedbackFruits, FlipGrip, Flop, Gynzy,
doi:10.1177/1751143720966280 Goguardian, Kami, G Suite, Kialo Edu, Hapara, Edx,
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Igbonagwam, et al.: Digital tools for clinical learning

Start.me, Ted‑Ed, Pronto, Skillshare, Parlay, Udemy, process of engaging with new tools and having little
WizIQ, Seesaw, Plurasight, Out and Lectura Inspire.[23] patience for navigating minor technical issues.[28]

Benefits of Digital Tools for Clinical In addition, the lack of infrastructure, technological
Learning limitations and poor Internet in many low‑ and
medium‑income countries deter the adoption of digital
Traditional clinical learning has its advantages, including clinical learning amongst both educators and students.[4]
closer networking and heightened opportunities to read
body language. Thus, a study by Dim et al. in Nigeria Prospects of Digital Learning
reported that some clinicians preferred physical to digital
learning, possibly because of their belief that clinical Innovation in digital technologies such as artificial
learning was mainly taught physically in the country.[24] intelligence, deep learning, machine learning, robotic
surgery, telemedicine, big data and next‑generation
However, the requirement of being in the same sequencing has led to ongoing development of
physical space became increasingly difficult with rising computer‑aided instruction (computer‑assisted
transportation costs, border limitations, insecurity and instruction), virtual reality (VR), augmented reality (AR)
recently the COVID‑19 pandemic lockdowns. The need and human patient simulation (HPS).[2,29,30]
for digital tools to aid traditional clinical learning was
conceptualised to address some of these limitations Computer‑aided instruction (computer‑assisted
of traditional method of learning and has become an learning)
integral tool of clinical learning in undergraduate, Computer‑assisted learning is the application of
post‑graduate and medical residency programmes of computers to aid or support the education or training
many countries. of people. Other terms include computer‑aided (or
computer‑assisted) instruction (CAI), computer‑based
Digital learning has been shown to reduce the cost and learning and computer‑managed instruction. They
time of traveling within and between countries. It assists are a range of computer‑based packages which focus
in security by avoiding travel to insecure areas or during on providing interactive instruction in a specific
insecure periods. It also assists in the maintenance of subject area.[31] CAI has been applied in monitoring,
social distancing – a key condition to limit the spread of surveillance, detection and prevention of COVID‑19
COVID‑19. Digital tools for clinical learning thus help in a study conducted on digital technology and
overcome the distance, time, security and cost barriers COVID‑19.[32] Computer simulations and interactive
to learning and improve the efficiency of training interfaces have been tried in pharmacology, prediction
programmes by enabling sessions to be taken more of depth of cancer invasion, psychiatry and diagnostic
frequently.[25] Digital learning has indeed revolutionised procedures.[33‑37]
learning by broadening the scope of learning, allowing
learners to learn at different paces and by having a global Virtual reality
reach.[26] VR is the immersion within a completely virtual
environment, which is often or most easily achieved by
Challenges of Digital Tools in Clinical taking over the entirety of a participant’s peripheral field
Learning of view via a head‑mounted display. Visual patients are
being utilised in all medical specialities at present.[38,39]
Lack of technical skills, including insufficient computer A comparative study showed that a group trained with
and typing skills, is one of the barriers that can be met the VR simulator had an overall better performance
by educators when engaging with the development and than those trained conventionally.[40] VR might also be
implementation of online learning, and this can inhibit used in robotic‑assisted surgery and resident procedural
the educator’s willingness or ability to engage in the trainings.
delivery of clinical learning using digital tools.[27]
Augmented reality
Amongst medical educators, the pressure of time to Augmented Reality (AR) overlays digital interfaces upon
allocate teaching, research and work–life balance might physical surroundings, producing an environment that
lead to minimal time left for mastery and development is both real and digital. This is unlike Virtual Reality
of digital materials.[28] The negative attitude amongst (VR) which utilises technology that creates artificial
educators in engaging with new technologies and environments through headsets that isolates users
tools can be seen as a barrier to the development and from their surroundings.[41] These applications are
implementation of digital tools in clinical learning. software and/or hardware developed explicitly with AR
Educators noted feeling overwhelmed with the entire functionality and have been applied to medical education
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Igbonagwam, et al.: Digital tools for clinical learning

as anatomical teaching tools, classroom study aids, Health (Abingdon) 2014;27:255‑61.

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Journal of the Medical Women’s Association of Nigeria - Volume 7, Issue 2, December 2022 35

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